The Education of the Occupational Health NurseAuthor(s): DOROTHY SMITHSource: Canadian Journal of Public Health / Revue Canadienne de Sante'e Publique, Vol. 66, No.6 (NOVEMBER/DECEMBER 1975), pp. 493-496Published by: Canadian Public Health AssociationStable URL: http://www.jstor.org/stable/41986083 .

Accessed: 17/06/2014 17:09

Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at .http://www.jstor.org/page/info/about/policies/terms.jsp

.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range ofcontent in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact support@jstor.org.

.

Canadian Public Health Association is collaborating with JSTOR to digitize, preserve and extend access toCanadian Journal of Public Health / Revue Canadienne de Sante'e Publique.

http://www.jstor.org

This content downloaded from 185.2.32.60 on Tue, 17 Jun 2014 17:09:48 PMAll use subject to JSTOR Terms and Conditions

Health Topic

The Education of the Occupational Health Nurse*

DOROTHY SMITH, B.Sc., M.P.H., O.H.N.C., R.N.1

My own professional career has been in the public health service of the Govern- ment of Alberta, while my experience in occupational health nursing has been in a technical institute where both technicians and tradesmen are qualified. It has been apparent to me for many years that there was a need for the public health nurse to have additional education in the special- ized field of occupational health. How- ever, until the last few years, little atten- tion has been paid to this need either by educational institutions, governments or nurses themselves.

It was the challenge posed to me by the Alberta Director of Industrial Health Services that helped me accept the fact that occupational health nursing is truly a nursing specialty. Very few professionals understand or acknowledge this concept.

I was determined to discover what this elusive term "occupational health" meant; and was fortunate to be admitted as a full-time student at the Royal College of Nursing, London, England. After seven months of intensive study I was granted a Certificate in Occupational Health Nursing.

The term "occupational health" was used officially for the first time in 1950 by the World Health Organization/ International Labour Organization expert committee on Occupational Health. The

♦ Presented at the Medical Services Branch, Health and Welfare Canada Occupational Health Nurses' Conference, Vancouver, B.C., June 23, 1975.

1. Supervisor, Health Services, Northern Alberta Institute of Technology, Edmonton, Alberta.

Committee stated that "Occupational Health should aim at the promotion and maintenance of the health of workers in all occupations."

The Royal College of Nursing was the first nursing organization in the world to use the name "Occupational Health Nursing", and has been offering the Certi- ficate in Occupational Health Nursing since 1954.

The areas of work of the occupational health nurse have not changed very much since industrial nursing came into being. But the emphasis has changed from a treatment service to the supervision of health of the individual and group, and the prevention of illness and injury.

In Britain, occupational health services are firmly established in the nationalized industries and in most of the major manu- facturing industries. It is estimated that half of the working population is covered by these services. The emphasis for service is now directed towards the work- ing population employed in smaller groups such as agriculture, small factories, shops, hotels, fishing and hospitals. Com- prehensive occupational health services are already being developed in British hospitals, based on the Report of the Joint Committee, The Care of the Health of Hospital Staff (1).

The Canadian scene is quite different. Senior nursing officers in our nursing associations, our teaching professors in universities and colleges, and our nursing colleagues find the concept of occupa- tional health difficult to understand. I must admit it took me many months of

studying in London before I began to see the relationship between my specialty, public health nursing, and occupational health nursing.

Occupational health nursing is con- cerned with the health needs of the employed population, while public health or community health is concerned with the health needs of the people living in the community. It will be seen at once that these two groups of persons may, at some time or other, be one and the same.

A mother, expecting a child, may be supervised in her pregnancy by the family physician, the Victorian Order of Nurses and the public health nurse. If she is a working mother, her health supervision, while at work, will be the responsibility of the occupational physician, nurse and hygienist or safety officer. You can understand how important it is to have open lines of communication between the public health and occupational health personnel for the benefit of the indivi- dual.

In Canada in 1972 there were 2,953,000 women in a total (employed and unemployed) labour force of 8,891,000 persons, representing 33.2% of the labour force, while men represented 66.8%. Of these women, 37.1% were married. Since 1962 the percentage of women in the employed labour force increased from 27.9% to 33.6% in 1972, which is an increase of 5.7% (2). They brought with them all the health and welfare problems associated with age levels from 14 years to over 65 years of age.

Canadian Journal of Public Health Vol. 66, November/December 1975 493

This content downloaded from 185.2.32.60 on Tue, 17 Jun 2014 17:09:48 PMAll use subject to JSTOR Terms and Conditions

According to A New Perspective on the Health of Canadians (3) some of these health problems can and should be pre- vented. It is in this area, both for males and for females, that the occupational health nurse can be of service to the employees. The nurses will be required to recognize the health and social needs of the neglected segments *of the Canadian population: the chronically ill, the senior citizen planning for retirement, the mentally ill, the economically deprived, the troubled parents, and the handi- capped. Once having identified the pro- blems the correction of them becomes a natural sequence of events, involving the occupational health nurse as a mediator.

In Canada, at the present time, through the provincial health insurance plans, the financial barriers to medical and hospital care have largely been elimi- nated. The underlying causes of sickness and death suggest that improvement in the environment and a reduction in the levels of risks imposed upon themselves by individuals constitute the most useful ways by which further improvement in the health of Canadians can be made.

The Government of Canada has pro- posed in the Lalonde working paper to pursue two broad objectives (4): "1 . To reduce mental and physical health

hazards for those parts of the Cana- dian population whose risks are high, and

2. To improve the accessibility of good mental and physical health care for those whose present access is unsatis- factory."

In pursuit of these two objectives, the Government of Canada has proposed five strategies: 1 . A Health Promotion Strategy. 2. A Regulatory Strategy. 3. A Research Strategy. 4. A Health Care Efficiency Strategy, and 5. A Goal Setting Strategy.

The Report suggests some possible courses of action which could be imple- mented. For example, under the Health Care Efficiency Strategy, concern is expressed not only with the accessibility of service but with the effectiveness of results. Some of the recommendations contained in the Report are directly related to the field of occupational

health. They are as follows: 1 . the extension of pre-paid care to addi-

tional essential services; 2. the strengthening of industrial and

emergency health services, including the training of personnel;

3. the identification, treatment and follow-up of Canadians with high blood pressure;

4. the support of programs designed to reduce the risk of premature coronary artery disease, including weight- control, exercise, stress reduction and anti-smoking;

5. the identification, treatment and follow-up of persons suffering from high serum cholesterol levels;

6. continued federal support for the training of health professionals;

7. the promotion of employer programs for employees with alcohol problems and

8. the continued extension of the role of nurses and nurse practitioners in the care of the mentally ill, the chronically ill, in the provision of home care, in family counselling on preventive health measures, both mental and physical, and in the reduction of environmental hazards and self- imposed risks. The Goal Setting Strategy has as one

of its recommendations that a renewed commitment should be made towards the health goals of the World Health Organi- zation and the Pan American Health Organization.

It is within these two broad objectives, the five main strategies and the numerous recommendations that Canadian health issues can be analysed and health policies can be developed. The intention of Government has been established; it now becomes a responsibility of the individual and society to become involved in the implementation of these proposals.

Occupational health workers will need to become increasingly more involved in the health care of employees. The ques- tion arises, are we prepared for the new challenges? Before this question can be answered a review of the term "Occupa- tional Health" is necessary.

The WHO/ILO definition stated (5): "Occupational health should aim t at:

the promotion and maintenance of the

highest degree of physical, mental and social well being of workers in all occupa- tions; the prevention among workers of departures from health caused by their working conditions; the protection of the workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psycho- logical equipment, and to summarize, the adaptation of work to man and of each man to his job."

This definition is still relevant today, but the emphasis is shifting from safety to health improvement and job satis- faction in the evaluation of work and the work environment of individuals. It is believed that the physical and psycho- social work environments must be improved in order to attain a better adjustment of work to man.

In 1972 a further I.L.O./W.H.O. Joint Conference was held in Milan on the teaching of Occupational Health and Safety (6). It was reported in the Con- ference report that three aspects of the work environment would soon require attention. First, the worker will demand not only safety and health at work, but less fatigue and improved comfort along with job satisfaction. Secondly, there will be more demands for health services, and thirdly, more people will demand the right to work.

If these aspects of the work environ- ment are attended to, the result will be improved work environments from the physical, physiological, psychological and social points of view. It will mean the Health Services will be required to develop and implement new methods to detect in the early stages deviations from normal health. It will also mean that the demand for jobs from the handicapped and elderly will call for occupational health programs specifically designed to adjust work to man and, through suitable placement, man to work.

This modern concept of the human work environment has many implications for education and training. But before we educate occupational health personnel there is a need to determine manpower needs, since the development of services

494 Canadian Journal of Public Health Vol. 66

This content downloaded from 185.2.32.60 on Tue, 17 Jun 2014 17:09:48 PMAll use subject to JSTOR Terms and Conditions

is dependent on qualified professionals to develop them.

Sweden recently established man- power needs for the occupational health team. In principle, they believe that a full-time occupational physician and a full-time occupational nurse are needed for every 2,000 workers. The same ratio was established for the safety and indus- trial/occupational hygiene engineer. Once these standards had been established, the number of persons who should be educat- ed for the jobs was then determined.

Canada has not developed such a formula, nor to my knowledge are there any plans in the immediate future to do so. Yet, if the programs in occupational health are to be expanded, attention will need to be given to determining needs and then educating personnel to fill the positions. The Grant MacEwan Com- munity College in Edmonton is the only post-secondary institution in Canada to offer a program in Occupational Health Nursing to students on a part-time basis. I had enrolled in this program but decided that the full-time program in London, at the Royal College of Nursing, might offer more advantages.

The program in London was very intensive and commenced with a basic one month introductory course leading into the Advanced Occupational Health Nursing Course which then required six months to complete. The main subjects were developed under two sections: 1 . Occupational Health Nursing 2. Occupational Health

1. Occupational Health Nursing included : i. Work in Health Department - in-

cluding field experience report writing

ii. Rehabilitation - field experience iii. Preparation for teaching - practical

experience iv. Ethics v. Counselling and Interviewing Tech-

niques vi. Psychology vii. Physiology viii. Environmental Control - field expe-

rience ix. Environmental Surveys - field expe-

rience

November/December 1975

2. Occupational Health: i. a) Introduction to Chemistry (6

hours) b) Toxicology

ii. Clinical Problems iii. Industrial Hygiene iv. Mental Health - Stress v. Ergonomics vi. Accident Prevention vii. Social Administration viii. Industrial Systems - labour rela-

tions, trade unions ix. Industrial field visits

The class was limited to 24 students and laboratory facilities were available for practical application of the physiology instruction. The program was worthwhile and my own philosophy of the close relationship between public health and occupational health was confirmed. To further substantiate this viewpoint let us review two definitions. According to the I.L.O./W.H.O. Committee on Occupa- tional Health (7), "Public Health is con- cerned with man in relation to his environment in society, outside the work place, and where factors such as air and water, pollution, noise, nutrition and infections may influence their health."

C.E.A. Winslow defines occupational health as (8) "The application of public health principles, and medical nursing and engineering practice for the purpose of conserving, promoting and restoring the health and effectiveness of workers through their place of employment."

The way in which the occupational health nurse develops these concepts depends largely on circumstances. In countries or areas within countries, where provision for the health needs of the population is minimal, employers may provide houses, schools, hospitals and other facilities for employees and their families. A nurse working for such employers may be required to carry out duties which under other circumstances would be performed by hospital and com- munity health nurses employed by non- industrial agencies. She sees the workers in the home as well as in the working situation; she cares for them when they are sick as well as promoting their health. So it would appear that the roles of the public health nurse and the occupational health nurse are interchangeable, depend-

ing on the education of the nurse, the needs of the community, and, in parti- cular, the policy of the employer.

We should remind ourselves of the fundamental responsibilities of a Regis- tered Nurse (9). They "are to promote health, alleviate suffering and conserve life, to practise skills and maintain pro- fessional knowledge at a consistently high level and to be fully aware of professional responsibilities and limitations."

The educational authorities have recognized that the basic nurse education, as presently constituted, is inadequate to qualify a nurse to undertake public health nursing duties. She is first required to obtain either a certificate or a baccalau- reate degree in nursing.

In 1969, eight countries had similarly agreed that post-secondary education was also necessary to qualify the registered nurse to undertake occupational health nursing responsibilities.

These countries were Australia, Austria, Egypt, Finland, Israel, Norway, Sweden, and the United Kingdom. To these countries we can add Canada and the United States. Outside the United Kingdom and Israel, there are very few nurses with a specialized qualification in Occupational Health Nursing. In the United Kingdom just under one-third working in the occupational health field hold a Certificate, while in Israel over two-thirds hold a qualification.

It would seem, therefore, that some educational authorities at both university and college level agree that the nurse employed in occupational health requires additional knowledge and skills to make her maximum contribution to safe- guarding the health of employees. These include (10): (a) a knowledge of approved occupa-

tional health nursing principles and of the company's policy regarding occupational health;

(b) an awareness of the potential rela- tionship between the work, the con- ditions of work and the health of the employee;

(c) a working knowledge of legislation relating to the health, safety and welfare of persons at work;

(d) sound clinical judgement to recog- nize the possible significance of apparently trivial signs and symp- toms;

495

This content downloaded from 185.2.32.60 on Tue, 17 Jun 2014 17:09:48 PMAll use subject to JSTOR Terms and Conditions

(e) an awareness of physical and toxico- logical risks to health, the methods of control, any preventive measures to be adopted and the appropriate first aid measures to be taken in the event of mishap;

(f) knowledge of interviewing tech- niques and teaching methods;

(g) skill in methods of communication; (h) an appreciation of the value of, and

the ability to maintain good inter- departmental relationships;

(i) the ability to work in professional isolation.

The occupational health nurse should be recognized as a specialist in her sphere of work."

She is required to assess the priorities and the available and potential resources in the situation in which she works, and plan her work within these constraints to provide the maximum service. She must identify the services already adequately provided by other specialist workers and plan her work in co-operation with them to provide as comprehensive a service as possible without duplication of service.

There are nursing functions which can be regarded as specific to the occupa- tional health nurse. They are as follows: i. Treatment of illness and injury

occurring at work. ii. Health supervision of the individual. iii. Advice, health education and coun-

selling. iv. Supervision of health aspects of the

environment. v. Administration.

For those of you who wish to study the nurses' functions in more detail, they are to be found in the Report of the Nursing Sub-Committee, 1966-1969, I.L.O./W.H.O. Permanent Commission and International Association on Occupational Health, "The Nurses' Contribution to the Health of the Worker" (11).

Education for Occupational Health Nursing

The education a nurse needs to work in occupational health is determined by: 1. the functions she will be expected to

perform and 2. the existing state of her knowledge.

The nurse will perform more efficient- ly if she has an opportunity to acquire an understanding of and an ability to use the

following concepts (12): "1. An understanding of the ages and

stages of man's development and his reaction to life situations;

2. An appreciation of the work of the nurse in the care of the well person;

3. An appreciation of the value of work;

4. An understanding of the problem- solving process and the ability to use this to identify a person's need for nursing care."

The type of Occupational Health Nursing education which would be ideal is being offered in Greece in a 4-year Public Health Nursing Diploma Program. The subjects taught include both public health and occupational health material and field experience is offered in the final year. A total of 924 hours of field expe- rience is given to each candidate.

Usually the preparation in Britain is offered in post-secondary institutions and consists of either full- or part-time courses extending from six months to eighteen months. The nurse attends classes for eighteen months, one day a week, and is released from her job to do so. She is eligible to sit the Royal College of Nursing examinations on completion of the experience.

It has been suggested by the experts that the curriculum for an applied pro- gram might include (13): (a) Principles of education; communica-

tion skills, health education; (b) The effects of the environment on

health; (c) The principles and practice of occu-

pational health nursing; (d) Community health services, hospital,

domiciliary and public health (personal and environmental), the role of the nurse in these fields and relevant legislation;

(e) Industrial structure; labour relations; industrial relations;

(f) Social structure and the forces of social change; social administration; social security including relevant legislation and social history.

The Nursing Sub-Committee of the Permanent Commission and International Association on Occupational Health (14) recommend that students should be actively involved in the learning process. The students should know how to seek out and use resources and to continue their own education. There should be a close integration of theory and practical application of specific nursing skills. The

preparation of the nurse for occupational health work is part of a continuing process of education. The program has to be planned on the foundations laid in previous professional education. In other words, what the nurse already knows must be evaluated. Once this is accom- plished it is the responsibility: i. of nurses to recognize their own need

for specialized education; ii. of Provincial Departments of Educa-

tion and of the universities and tech- nical colleges to provide the educa- tional programs;

iii. of the Federal and Provincial Govern- ments to provide the financial encouragement to interested, capable nurses;

iv. of the employers to provide the opportunity for nurses to take advantage of these arrangements.

I leave you with these challenges. REFERENCES

1. England and Wales. Ministry of Health. The Care of the Health of Hospital Staff. Report of the Joint Committee. London, H.M.S.O.. 1969.

2. Canada. Labour Canada, Women's Bureau. Women in the Labour Force - Facts and Figures. Ottawa, 1973.

3. Lalonde, Marc. A New Perspective on the Health of Canadians. Ottawa, Health and Welfare Canada, 1974.

4. Ibid., p. 66. 5. Unpublished document W.H.O./Occ.

Health/2, p. 3. 6. International Labour Organization/World

Health Organization. The Teaching of Occupational Health and Safety: Report on a Conference. Milan, International Labour Organization and the W.H.O. Regional Office for Europe, June 26-30, 1972.

7. Joint I.L.O./W.H.O. Committee on Occu- pational Health, First Session, 1950.

8. Winslow, C.E.A. The Evolution and Significance of the Modern Public Health Campaign. New Haven, Connecticut, 1923, p. 1.

9. Royal College of Nursing and National Council of Nurses of the United Kingdom. Occupational Health Nursing. London, 1973, p. 9.

10. Ibid., p. 10. 11. I.L.O./W.H.O. Permanent Commission and

International Association on Occupational Health. Report of the Nursing Sub- Committee, 1966-1969. The Nurses' Contribution to the Health of the Worker, pp. 9, 10.

12. Ibid., p. 19. 13. World Health Organization, Regional

Office for Europe* Joint ILO/WHO Seminar on The Nurse in Industry. Copenhagen, 1957, pp. 52, 53.

14. I.L.O./W.H.O. Permanent Commission and International Association on Occupational Health. Report of the Nursing sub- Committee, 1971-73. The Nurses' Contri- bution to the Health of the Worker. Report No. 2, Education of the Nurse, p. 12.

496 Canadian Journal of Public Health Vol. 66

This content downloaded from 185.2.32.60 on Tue, 17 Jun 2014 17:09:48 PMAll use subject to JSTOR Terms and Conditions